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Delayed diagnosis of bladder cancer (11HDC00843)

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(11HDC00843, 22 March 2013)

General practitioner ~ Urologist ~ Painless macroscopic haematuria ~ Referral ~ Delay in diagnosis ~ Right 4(1)

A man complained about the care provided by his general practitioner, who failed to initiate timely investigations, leading to a delayed diagnosis of bladder cancer.

The 48-year-old man consulted his GP on three occasions over ten months complaining of blood in his urine (macroscopic haematuria) with no accompanying pain. At the first and second consultations, the GP put this down to a urine infection and prescribed an antibiotic.  The GP did not order any investigations, and did not sufficiently warn the man that the haematuria could indicate serious pathology and that he should therefore be attentive to any recurrence.

When the man presented to the GP a third time with the same complaint, the GP ordered investigations and referred the man to a urologist. An ultrasound revealed that the man had a large bladder tumour, which was subsequently treated surgically.

It was held that when the man first presented with painless macroscopic haematuria, the GP should have ordered laboratory tests to exclude infection. If infection was absent, secondary investigations should have been carried out. The need for action to be taken to investigate the haematuria was even greater when the man presented for a second time, six months later, with the same concerns. The GP's failure to investigate the haematuria or refer him to a specialist at the first and second consultations was a breach of Right 4(1).

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